We Need To Act More Like Engineers

All improvement requires change, but, not every change results in improvement. Engineers are taught this. Medical education and nursing education have only recently begun to include systems thinking in their curricula. I was speaking with one of my most trusted colleagues, Dave Hynson, our Chief Information Officer, and he was reminding me how we are pushing to shorten the time to action. We want to move faster towards our vision, but, we have to be careful when we create change so that it actually leads to improvement. Dave and I were talking about some recent examples of changes that went well and others where we may have skipped some steps and moved too soon to implementation.

I have spoken in this blog before about Walter Shewhart http://ahealthydialogue.blogspot.com/2013/10/continuous-improvement-method-that-will.html, a giant in the history of the application of science to industrial quality. Walter was a physicist, engineer and statistician. He worked at Bell Laboratories in the early 20th Century and was responsible for many early telephone improvements. He is also known for the famous Shewhart or PDSA cycle: plan, do, study, act. He taught many industries how to apply the scientific process to the creation of a product. Prior to his work, many business owners thought that poor quality was always due to lack of effort by the workers.

Today, we know, especially in health care, that we have an incredibly smart, dedicated, well-trained and hard- working staff.  We are desperate to deliver on the quadruple aim and we know we need to change and people like me want the improvements to have happened “yesterday”. Because of this, some of our people are doing plan-do, plan-do, plan-do. Dr. Shewhart, being an engineer knew that not all changes result in improvement and that is why the cycle is plan-do-study and only then – act.

We are a bit too quick to create a change that we think will help and roll it out. We are much better off if we declare our aim first and then ask ourselves “how will we know if a change is an improvement?” and only then begin thinking about what we could change. Once we have an idea we must test it on a small scale to see if it will work. After we test it, we should study our results and then based on how it went, either implement our change or do the next test.

When we push things out into use without testing them first, we are less likely to have a smooth implementation that achieves our original aim. Bell telephones were the world-wide standard for telecommunications’ excellence in the 20th century thanks to the work of Shewhart and his colleagues. Let’s become the same for healthcare excellence in the 21st century using his methodology.